So what should patients do in the meantime?
It is far too early to start advocating ACE inhibitors for all elderly patients. Switching patients to centrally acting ACE inhibitors is a difficult and an expensive undertaking and should only be done on a case-by-case basis. The director of the above study, Dr Sink, recommends that, “if the patient does not have a contraindication for an ACE inhibitor, then switching to a centrally active ACE inhibitor is a reasonable choice. In addition, for those already on ACE inhibitors, our study results would support the use of a centrally active ACE inhibitor over a non–centrally active one."
Centrally active ACE inhibitors included captopril (Capoten, Bristol-Myers Squibb), fosinopril (Monopril, Bristol-Myers Squibb), lisinopril, perindopril, ramipril (Altace, King Pharmaceuticals), and trandolapril (Mavik, Abbott Laboratories). Non–centrally active ACE inhibitors included benazepril (Lotensin, Novartis Pharmaceuticals), enalapril (Vasotec, Merck), moexipril (Univasc, Schwarz Pharma), and quinapril (Accupril, Pfizer).
The study is published in the July 13 issue of Archives of Internal Medicine.
http://www.medscape.com/viewarticle/706401
Saturday, July 25, 2009
Can Centrally Acting anti hypertensive medications reduce Dementia? Part 1
Angiotensin-converting enzyme (ACE) inhibitors are important for control of blood pressure and have made a profound impact on patients with diabetes and congestive heart failure. The ACE inhibitors, which act outside the brain, have had minimal impact on dementia of any cause. However, there is now evidence indicating that ACE Inhibitors which act inside the brain, may have the ability to reduce cognitive decline.
Recent observational data from the Cardiovascular Health Study revealed that that centrally active ACE inhibitors did diminish cognitive decline by 65% per year of exposure, an effect that is likely related to the drug’s ability to cross the blood-brain barrier.
The study included 414 subjects who had been administered ACE inhibitors and 640 who had taken other antihypertensive medications. The researchers found no connection between exposure to all ACE inhibitors and risk for dementia, difference in cognitive-function scores, or odds of disability.
However, further analysis according to type of ACE inhibitor showed an unusual benefit. The results revealed that centrally active ACE inhibitors were associated with 65% less decline in cognitive-function scores per year of exposure.
This lessening in cognitive decline is not felt to be due to better control of blood pressure but most likely related to the drug’s effects on the brain's intrinsic renin-angiotensin system, which is felt to be valuable in memory and cognition. There is some laboratory evidence showing that stimulation of the renin-angiotensin system also provokes activation of inflammatory mediators which have been implicated in causing degenerative dementias.
For patients with dementia, this may be good news. There has been a huge public demand to find an intervention that can prevent or slow cognitive decline. However, the above study has to confirmed in a randomized clinical trial to determine if the above results are in fact a true observation.
Recent observational data from the Cardiovascular Health Study revealed that that centrally active ACE inhibitors did diminish cognitive decline by 65% per year of exposure, an effect that is likely related to the drug’s ability to cross the blood-brain barrier.
The study included 414 subjects who had been administered ACE inhibitors and 640 who had taken other antihypertensive medications. The researchers found no connection between exposure to all ACE inhibitors and risk for dementia, difference in cognitive-function scores, or odds of disability.
However, further analysis according to type of ACE inhibitor showed an unusual benefit. The results revealed that centrally active ACE inhibitors were associated with 65% less decline in cognitive-function scores per year of exposure.
This lessening in cognitive decline is not felt to be due to better control of blood pressure but most likely related to the drug’s effects on the brain's intrinsic renin-angiotensin system, which is felt to be valuable in memory and cognition. There is some laboratory evidence showing that stimulation of the renin-angiotensin system also provokes activation of inflammatory mediators which have been implicated in causing degenerative dementias.
For patients with dementia, this may be good news. There has been a huge public demand to find an intervention that can prevent or slow cognitive decline. However, the above study has to confirmed in a randomized clinical trial to determine if the above results are in fact a true observation.
Thursday, July 23, 2009
Finally a treatment for hair pulling? Part 2
How N acetyl cysteine prevents hair pulling is not fully understood but is believed to act in the brain and reduces activity of a neurotransmitter, called glutamate. It is believed that glutamate mat play a role in the compulsion to pull hair. When levels of glutamate are reduced, the drive to pull hair also disappears.
There have been previous anecdotal reports and case series which have also reported that N acetyl cysteine may reduce the urge to use illicit drugs like cocaine.
The dose of N acetyl cysteine used in the study varied from 1.2- 4 grams per day. Even though hair-pulling episodes declined, most individuals did not see a marked improvement in their quality of life.
So what about the individual who has Trichotillomania?
One should understand that this is only one study that shows benefits of N acetyl cysteine for hair pulling. The supplement is easily available without a prescription from any health food store and is relatively safe to ingest. The cost of N acetyl cysteine is also substantially lower than all presently prescribed drugs for the disorder. Therefore, if you have a habit of puling your hair and would like to stop it, N acetyl cysteine may not be a bad idea. Of course, if it does not work within 2-3 months, then the above study was hogwash.
Archives of general psychiatry, 2009-07-18
There have been previous anecdotal reports and case series which have also reported that N acetyl cysteine may reduce the urge to use illicit drugs like cocaine.
The dose of N acetyl cysteine used in the study varied from 1.2- 4 grams per day. Even though hair-pulling episodes declined, most individuals did not see a marked improvement in their quality of life.
So what about the individual who has Trichotillomania?
One should understand that this is only one study that shows benefits of N acetyl cysteine for hair pulling. The supplement is easily available without a prescription from any health food store and is relatively safe to ingest. The cost of N acetyl cysteine is also substantially lower than all presently prescribed drugs for the disorder. Therefore, if you have a habit of puling your hair and would like to stop it, N acetyl cysteine may not be a bad idea. Of course, if it does not work within 2-3 months, then the above study was hogwash.
Archives of general psychiatry, 2009-07-18
Finally a treatment for hair pulling? Part 1
Hair pulling is a relatively common disorder in the general population. This agonizing disorder is more common in females and is often associated with an obsessive compulsive personality. Current estimates indicate that at least 2 million adult Americans over the age of 20 have this disorder. There are countless more individuals who have not been diagnosed or are too shy to visit a physician. Despite being aware about this disorder for decades, the treatment for hair pulling or Trichotillomania has not been very satisfactory. Over the years, countless treatments have come and gone. Today, pharmacological drug therapy and behavior alterations are the mainstay of treatment but have limited success.
Recently a paper published in the Archives of General Psychiatry offers new hope for patients who suffer from Trichotillomania. In a small trial involving 50 individuals, it was observed that those who took the health supplement, N acetyl cysteine, had marked improvement of symptoms after only 12 weeks. N acetyl cysteine used in the study was obtained in a pill form from health food stores like GNC and Vitamin Shoppe.
If these studies do hold up, then this may herald a potentially new treatment for this disturbing disorder.
Why people pull hair remains a puzzle and there are countless theories. The bottom line is that chronic hair pulling is a diversion from a stressful situation, which eventually turns into addictive psychological relief. The majority of individuals not only pull hair from the scalp but also from other parts of the body. At least 20 percent of individuals even eat their hair and a very few minority pull other people’s hair. While hair-pulling sounds painful, most trichotillomanics claim that it provides a calming feeling and relief from the acute anxiety.
Recently a paper published in the Archives of General Psychiatry offers new hope for patients who suffer from Trichotillomania. In a small trial involving 50 individuals, it was observed that those who took the health supplement, N acetyl cysteine, had marked improvement of symptoms after only 12 weeks. N acetyl cysteine used in the study was obtained in a pill form from health food stores like GNC and Vitamin Shoppe.
If these studies do hold up, then this may herald a potentially new treatment for this disturbing disorder.
Why people pull hair remains a puzzle and there are countless theories. The bottom line is that chronic hair pulling is a diversion from a stressful situation, which eventually turns into addictive psychological relief. The majority of individuals not only pull hair from the scalp but also from other parts of the body. At least 20 percent of individuals even eat their hair and a very few minority pull other people’s hair. While hair-pulling sounds painful, most trichotillomanics claim that it provides a calming feeling and relief from the acute anxiety.
Sunday, July 19, 2009
Can the Mediterranean diet prevent Alzheimer’s dementia? Part 1
Over the years, there has been a great interest in ways to delay or prevent Alzheimer’s dementia. Besides use of drugs, some researchers feel that perhaps a change in diet may help prevent the decline in cognitive impairment that occurs in old age. It is widely believed that a healthy diet may help prevent development of mild cognitive impairment (MCI) and delay onset of Alzheimer’s disease (AD).
Current estimates indicate that about 10% to 15% of individuals with MCI convert to AD each year.
One of the diets thought to have some benefit in delaying mild cognitive impairment is the Mediterranean diet. Previous clinical research revealed that conformity to a Mediterranean diet was linked to a reduced risk for AD, but its effect on developing MCI was unknown.
The recent study from Washington Heights Inwood Columbia Aging Project (WHICAP) looked at the benefits of adherence to a Mediterranean diet and development of mild cognitive impairment over several years.
To explore whether cognitively normal individuals whose food intake was more representative of a Mediterranean diet were less likely to develop MCI, the researchers examined data from 1393 cognitively normal individuals and 484 individuals with MCI who were participants in the WHICAP multiethnic community study in New York. The majority of individuals studied were in the 7/8th decade of life. Study participants were given a score of 0 to 9 based on their faithfulness to a Mediterranean diet, where 9 indicated greatest adherence to this diet.
Strong adherence to a Mediterranean diet was characterized by a high intake of fish, fruit, vegetables, legumes, cereals, and unsaturated fat; a low intake of dairy products and meat; and a moderate intake of alcohol/wine.
Current estimates indicate that about 10% to 15% of individuals with MCI convert to AD each year.
One of the diets thought to have some benefit in delaying mild cognitive impairment is the Mediterranean diet. Previous clinical research revealed that conformity to a Mediterranean diet was linked to a reduced risk for AD, but its effect on developing MCI was unknown.
The recent study from Washington Heights Inwood Columbia Aging Project (WHICAP) looked at the benefits of adherence to a Mediterranean diet and development of mild cognitive impairment over several years.
To explore whether cognitively normal individuals whose food intake was more representative of a Mediterranean diet were less likely to develop MCI, the researchers examined data from 1393 cognitively normal individuals and 484 individuals with MCI who were participants in the WHICAP multiethnic community study in New York. The majority of individuals studied were in the 7/8th decade of life. Study participants were given a score of 0 to 9 based on their faithfulness to a Mediterranean diet, where 9 indicated greatest adherence to this diet.
Strong adherence to a Mediterranean diet was characterized by a high intake of fish, fruit, vegetables, legumes, cereals, and unsaturated fat; a low intake of dairy products and meat; and a moderate intake of alcohol/wine.
Sunday, July 12, 2009
Melatonin and jet lag?
One of the hassles about long distance air travel is jet lag. Jet lag occurs when the body’s internal rhythms no longer work in synchrony. The day and night cycle become disturbed and the individual often requires several days to get back into his/her normal rhythm. There is evidence that melatonin, a hormone released from the pineal gland, is important when it comes to regulating many body rhythms and the sleep-wake cycle. For decades, melatonin has been sold in health stores as an aid for sleep and help recovery from jet lag.
Millions of pills of melatonin are bought by consumers to treat jet lag, but is melatonin effective?
Cochrane reviews recently looked at 10 randomized clinical trials in which melatonin were used by airline personnel, military employees and other regular airline passengers. Melatonin was compared to a sugar pill. The outcome measures looked at subjective well being daytime tiredness, onset, quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms.
The studies found that melatonin was quite effective when taken close to the target bedtime at the destination, decreased jet lag from flights crossing 5 or more time zones. Daily doses of melatonin between 0.5 and 5mg were both equally effective, except that people started to fall asleep a lot faster when using the higher dose. Doses above 5mg appeared to be no more effective than the lower doses of melatonin.
A slow release preparation of 2 mg melatonin also worked well at inducing sleep. Some studies indicated that this formulation may be of more benefit when greater than 4-5 time zones are crossed.
The studies revealed that timing of the melatonin dose was important. If the melatonin was taken at the wrong time or very early in the day, it was likely to cause sleepiness and delay adaptation to local time. The incidence of other side effects was low. A number of case reports have also suggested that individuals with epilepsy and patients taking warfarin (blood thinner) might come to harm from melatonin.
Conclusion
Melatonin is quite effective in preventing or reducing jet lag, and for short-term use appears to be safe. It may be a choice for jet lag treatment for travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys. Despite these positive reports, there are a lot of anecdotal reports that melatonin often fails to work. The reason(s) for these discrepancies are not well understood, but more likely than not, are probably related to fake or counterfeit products.
http://www.cochrane.org/reviews/en/ab001520.html
Millions of pills of melatonin are bought by consumers to treat jet lag, but is melatonin effective?
Cochrane reviews recently looked at 10 randomized clinical trials in which melatonin were used by airline personnel, military employees and other regular airline passengers. Melatonin was compared to a sugar pill. The outcome measures looked at subjective well being daytime tiredness, onset, quality of sleep, psychological functioning, duration of return to normal, or indicators of circadian rhythms.
The studies found that melatonin was quite effective when taken close to the target bedtime at the destination, decreased jet lag from flights crossing 5 or more time zones. Daily doses of melatonin between 0.5 and 5mg were both equally effective, except that people started to fall asleep a lot faster when using the higher dose. Doses above 5mg appeared to be no more effective than the lower doses of melatonin.
A slow release preparation of 2 mg melatonin also worked well at inducing sleep. Some studies indicated that this formulation may be of more benefit when greater than 4-5 time zones are crossed.
The studies revealed that timing of the melatonin dose was important. If the melatonin was taken at the wrong time or very early in the day, it was likely to cause sleepiness and delay adaptation to local time. The incidence of other side effects was low. A number of case reports have also suggested that individuals with epilepsy and patients taking warfarin (blood thinner) might come to harm from melatonin.
Conclusion
Melatonin is quite effective in preventing or reducing jet lag, and for short-term use appears to be safe. It may be a choice for jet lag treatment for travelers flying across five or more time zones, particularly in an easterly direction, and especially if they have experienced jet lag on previous journeys. Despite these positive reports, there are a lot of anecdotal reports that melatonin often fails to work. The reason(s) for these discrepancies are not well understood, but more likely than not, are probably related to fake or counterfeit products.
http://www.cochrane.org/reviews/en/ab001520.html
Monday, July 6, 2009
Can testosterone supplements help relieve schizophrenia?
Schizophrenia is a common malady in our society. Estimates indicate that close to 1% of people in North America suffer from schizophrenia. The disorder affects all races, cultures, and both genders. The disorder is associated with inability to determine what is real. These individuals may develop false beliefs, hallucinations, distorted perceptions and have emotional withdrawal. Over time, most schizophrenics develop apathy.
Over the years, the major treatment for schizophrenia has been based on use of drugs. Each and every pharmaceutical anti psychotic drug available today has its pros and cons; there is no ideal drug and many of these drugs also have profound side effects. In the last two decades, there has been a push by some health workers to recommend sex hormones, estrogen and testosterone, for the treatment of schizophrenia. So far, there is not a single study that has shown a correlation between low levels of testosterone and schizophrenia, and in fact, many individuals with low levels of testosterone never develop schizophrenia. Nevertheless, like all things in medicine, there are always some unorthodox health care workers who view things differently and put into practice unsubstantiated theories.
Over the decades, many individuals with schizophrenia have been treated with dehydroepiandrosterone (DHEA) as an adjunctive therapy to standard anti psychotic drugs.
The question remains, is testosterone helpful for schizophrenia?
Literature analysis of three small studies compared anti psychotic drugs to DHEA and a sugar pill.
What about the results?
There was no evidence that supplementing testosterone benefitted schizophrenics. Even though the number of patients studied was small, there was no benefit seen. Testosterone did not help improve any of the symptoms of schizophrenia. The only positive thing to come out of the study was that short-term use of testosterone was not found to be associated with any harmful side effects.
Therefore, for the moment, schizophrenia is still treated with conventional pharmaceutical drugs and use of sex hormones remains experimental. Individuals who want to use testosterone or any other supplement for schizophrenia should first consult with their psychiatrist. All individuals should be aware that long-term use of testosterone is associated with many side effects including masculinization; a number of side effects are irreversible even when the hormone is stopped
http://www.cochrane.org/reviews/en/ab006197.html
Over the years, the major treatment for schizophrenia has been based on use of drugs. Each and every pharmaceutical anti psychotic drug available today has its pros and cons; there is no ideal drug and many of these drugs also have profound side effects. In the last two decades, there has been a push by some health workers to recommend sex hormones, estrogen and testosterone, for the treatment of schizophrenia. So far, there is not a single study that has shown a correlation between low levels of testosterone and schizophrenia, and in fact, many individuals with low levels of testosterone never develop schizophrenia. Nevertheless, like all things in medicine, there are always some unorthodox health care workers who view things differently and put into practice unsubstantiated theories.
Over the decades, many individuals with schizophrenia have been treated with dehydroepiandrosterone (DHEA) as an adjunctive therapy to standard anti psychotic drugs.
The question remains, is testosterone helpful for schizophrenia?
Literature analysis of three small studies compared anti psychotic drugs to DHEA and a sugar pill.
What about the results?
There was no evidence that supplementing testosterone benefitted schizophrenics. Even though the number of patients studied was small, there was no benefit seen. Testosterone did not help improve any of the symptoms of schizophrenia. The only positive thing to come out of the study was that short-term use of testosterone was not found to be associated with any harmful side effects.
Therefore, for the moment, schizophrenia is still treated with conventional pharmaceutical drugs and use of sex hormones remains experimental. Individuals who want to use testosterone or any other supplement for schizophrenia should first consult with their psychiatrist. All individuals should be aware that long-term use of testosterone is associated with many side effects including masculinization; a number of side effects are irreversible even when the hormone is stopped
http://www.cochrane.org/reviews/en/ab006197.html
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